| NPI | 1669606398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2014009215) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-38524) |
| Enumeration Date | 2009-05-09 |
| Last Update Date | 2025-10-02 |